Elective Surgery - Bureau of Health Information

[Pages:24]Elective Surgery

Hospital Quarterly: Performance of NSW public hospitals

January to March 2014

Elective surgery, often called planned surgery, is surgery that a doctor considers necessary but can be delayed by at least 24 hours. Common examples of elective surgery include hip replacements, cataract extraction and ligament repairs. There are three categories of elective surgery: non-urgent, semi-urgent and urgent (see page 2 for a description of these categories).

There were 49,486 elective surgical procedures performed in January to March 2014, three per cent more than the number conducted in the same quarter one year ago.

Compared with the same quarter last year, the volume of non-urgent surgery increased by five per cent, semi-urgent increased by three per cent and urgent increased by one per cent.

Most patients (97%) received their surgery on time in NSW. This is unchanged from the previous quarter (October?December 2013), but an improvement of two percentage points from the same quarter last year. The percentage point increases in patients receiving surgery by category is shown in the table below.

This edition again includes analyses of the differences between NSW hospitals in terms of important factors that can influence a patient's time spent on the waiting list in each category.

Information at the hospital, LHD and peer group level from this issue of Hospital Quarterly will also be available for viewing and downloading on the Bureau's new online interactive tool Healthcare Observer. Visit bhi..au/healthcareobserver

During the quarter

Elective surgical procedures performed Elective surgery patients treated on time

Urgent elective surgery patients treated on time Semi-urgent elective surgery patients treated on time Non-urgent elective surgery patients treated on time

Jan?Mar 2013 Jan?Mar 2014 The difference

48,009 procedures 95% 99% 94% 94%

49,486 procedures 97% 100% 97% 96%

1,477 procedures (+3%) +2 percentage points +1 percentage points +3 percentage points +2 percentage points

Hospital Quarterly: Elective Surgery January to March 2014 bhi..au

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Our approach to elective surgery reporting

If a person and their surgeon agree surgery is required but can be delayed by at least 24 hours, the surgeon will recommend the patient is placed on the waiting list for the procedure and assigns them to one of three urgency categories. Each category has its own target, which specifies the desired maximum time (in days) the patient should wait for their procedure. These are outlined in the box below.

Urgency categories: Elective surgery guidelines

Category 1 Urgent

(eg, heart valve replacement, amputation of limb)

Admission within 30 days desirable for a condition that has the potential to deteriorate quickly and become an emergency

Category 2 Semi-urgent

(eg, colposcopy, amputation of digit)

Admission within 90 days desirable for a condition not likely to deteriorate quickly

Category 3 Non-urgent

(eg, septoplasty)

Admission within 365 days acceptable for a condition not likely to deteriorate quickly

Explaining staged surgery

There are times when surgery is deemed necessary but should not, or cannot, take place until a period of time has passed. This time is determined by a clinician and is necessary for the surgery to be effective. This is called staged surgery and is an essential concept in managing elective surgery. It allows surgeons to place patients on the waiting list but prevents them from being admitted to hospital before it is clinically appropriate. Surgeons use clinical judgement to decide whether a procedure should be categorised as staged or not. One example of a staged procedure is waiting for

a broken bone to heal before removing pins or plates. The Bureau excludes staged and nonurgent cystoscopy procedures from performance measures.

Reporting waiting times

To provide a comprehensive picture of the variation in times that patients waited for surgery, the Bureau reports the 90th percentile time and the median wait time by urgency category. The median waiting time for patients who received surgery is also presented by the specialty of the surgeon and by common procedures.

The Bureau also reports on patients who are currently on the waiting list to have their surgery. For these patients, the Bureau reports by urgency category, specialty of the surgeon and most common procedures. The number of patients who have been waiting for more than 12 months is reported for each hospital and by the specialty of the surgeon for NSW.

The Bureau is committed to providing clarity on surgical waiting times in NSW. Further detail on our methods can be found in the Bureau's Hospital Quarterly Technical Supplement: Elective surgery measures, January to March 2013 available on the Bureau's website at bhi..au

See the Appendices section of this report (pages 22 to 23) for more detailed performance information about each public hospital providing elective surgery in NSW. This includes Hawkesbury Private Hospital, which is contracted to supply surgery for public patients.

Hospital Quarterly: Elective Surgery January to March 2014 bhi..au

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In this Report

The Bureau of Health Information's Hospital Quarterly provides a detailed assessment of waiting times to receive elective surgery and achievement of the target of all patients receiving their elective surgery within the recommended timeframe.

As in the previous issue of Hospital Quarterly, the Bureau presents analyses of the differences between NSW hospitals by considering important factors that can influence a patient's time spent on the waiting list for urgent, semiurgent and non-urgent surgery.

These analyses are for patients who received their surgery in the January to March 2014 quarter.

Factors considered in this section are:

? the urgency of the surgery received (i.e. urgent, semi-urgent, non-urgent)

? the number of elective surgery procedures performed in each hospital

? the peer group of the hospital

Hospitals are grouped by hospital type or 'peer groups'. A definition of each peer group is listed below.

Peer groups

NSW hospitals vary in size and the types and complexity of clinical services that they provide. To enable valid comparisons to be made between hospitals, it is important to compare similar or like hospitals together. To do this, the Bureau uses a NSW Health classification system called `peer group'. The hospital peer groups included in this report are described in the table below:

Group A1

Name Principal referral

A2 Paediatric specialist

A3

Ungrouped acute

? tertiary referral

B

Major

C1 District group 1

C2 District group 2

Description Very large hospitals providing a broad range of services, including specialised units at a state or national level. Specialist hospitals for children and young people. Major specialist hospitals that are not similar enough to any other peer group to be classified with them. Large metropolitan and non-metropolitan hospitals. Medium sized hospitals treating between 5,000?10,000 patients each year. Smaller hospitals, typically in rural locations.

Hospital Quarterly: Elective Surgery January to March 2014 bhi..au

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Number of elective surgery procedures performed

During January to March 2014, the Waiting List Collection On-line System (WLCOS) recorded that 49,486 patients were admitted from the waiting list to receive an elective surgery procedure in NSW public hospitals or facilities contracted by

NSW hospitals. This is 9% lower than the number conducted in the previous quarter and 3% higher than the 48,009 surgical procedures completed in the same quarter last year (Figure 1).

Figure 1: Total number of elective surgery procedures conducted, by urgency category, January 2012 to March 2014

1 Urgent

2 Semi-urgent

3 Non-urgent

4 Staged procedures1

25,000

20,000

15,000

10,000

5,000

0 2012

Jan?Mar 2012

2013 2014

2012

2013 2014

2012

2013 2014

Apr?Jun 2012

Jul?Sep 2012

Oct?Dec Jan?Mar

2012

2013

Apr?Jun 2013

Jul?Sep 2013

2012

2013 2014

Oct?Dec Jan?Mar

2013

2014

All categories Urgent1 Semi-urgent1 Non-urgent2

Staged procedures3

48,497 11,587 15,199 18,434

3,277

52,537 12,517 16,707 19,844

3,469

55,843 13,750 17,693 21,011

3,389

53,728 13,296 17,000 20,064

3,368

48,009 10,552 15,137 19,087

3,233

55,121 12,704 17,472 21,596

3,349

57,760 13,505 18,687 22,129

3,439

54,288 13,084 17,792 20,152

3,260

49,486 10,613 15,562 20,135

3,176

1. Including non-urgent cystoscopy. Source: NSW Health, Waiting List Collection On-line System. Data for July 2013 to March 2014 extracted on 22 April 2014. Data

for January 2013 to June 2013 extracted on 16 March 2014. Data for all quarters from January 2012 to March 2013 extracted on 17 April 2013. Data for all previous quarters extracted on 15 October 2011.

Small number suppression

Some hospitals conduct very few surgical procedures. Publishing these small numbers could lead to some cases being recognised and can also affect the accuracy of the data. The Bureau suppresses information based on very few patients. If there are fewer than five patients in any group, patient numbers are displayed as ................
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